Impact Of Immunohistochemistry Research Articles

Histopronostic factors in superficial colorectal adenocarcinomas treated by endoscopy: reproducibility and impact of immunohistochemistry and digital pathology

Endoscopic dissection is the first-choice treatment for superficial pT1 colorectal adenocarcinoma (sCRC). Complementary surgery decision is influenced by histopronostic factors. Prognostic significance and reproducibility of each factor are not well established. The role of immunohistochemistry (IHC) and digital pathology in this context is unknown. Our aims were (1) to evaluate each histopronostic factor reproducibility comparing HES and IHC ± digital pathology and (2) to evaluate how the different techniques would affect indications for additional surgery. We performed a single-centre retrospective study of 98 patients treated between 2010 and 2019 in Hospices Civils de Lyon, France. We analyzed physical or digital slides of HES and keratin/desmin immunostaining of 98 sCRC dissection specimens. Three pathologists evaluate the histopronostic factors including submucosal invasion depth (SMI) measured using different recommended methods. Assessment of SMI with Ueno or JSCCR methods showed good to excellent interobserver reproducibility (IOR) (ICCs of 0.858 to 0.925) using HES staining and IHC. Assessment of budding on HES sections was poorly reproducible compared to IHC which exhibit moderate IOR (κ = 0.714). IHC increased high-grade budding detection. For lymphovascular invasion and poor differentiation, the IOR was poor (κ = 0.141, 0.196 and 0.313 respectively). IHC gave a better reproducibility for further treatment indication according to JSCCR criteria (κ = 0.763) or forthcoming European guidelines (κ = 0.659). Digital pathology was equivalent to the microscope for all analyses. Histopronostic factor reproducibility in sCRC is moderate. Immunohistochemistry may facilitate the evaluation of certain criteria and improve the reproducibility of treatment decisions.

Abstract 4: Impact of Immunohistochemistry on Diagnostic Accuracy for Pediatric Cancer in Tanzania

Abstract Purpose: The current study evaluates the impact of immunohistochemistry (IHC) on diagnostic accuracy for pediatric cancer in Tanzania, and identifies the most common biomarkers used for diagnostic differentiation in our setting. Methods: Pathology samples for children diagnosed with cancer at Bugando Medical Centre (Mwanza, Tanzania) in 2018 were evaluated using H&E staining. Basic demographic information from histology form was recorded, including patient age, sex, and sample collection, as well as the reported histopathology results from BMC. Additional tissue from histology block was sent to Muhimbili National Hospital for IHC review. The histopathology results were compared for diagnostic agreement, change in diagnosis, and identified which biomarkers were necessary for diagnostic confirmation. Results: One hundred and five (105) pediatric cancer patients were reviewed. 58 (55.2%) were female median age of 6 years (IQR 3-9 years). Most common pediatric diagnoses were Burkitt lymphoma and Non Hodgkin Lymphoma specifically Diffuse Large B-cell lymphoma, anaplastic large cell lymphoma, FL, LL. Overall histology concordance between H&E and IHC was 51.0%. Most common discordant diagnosis was NHL of ALCL (ALK1-negative, CD-45, 30-positivity). Most concordant was Leukemia (BCR-ABL). Diagnostic specificity (example: in Non-Hodgkin Lymphoma) improved for 17.6% (n=18). The most common diagnosis with increased specificity was DLBCL. Among NHL, 39% (n=7) were ALCL, 27% (n=5) DLBCL, 17% (n=3) Lymphoblastic Lymphoma, 17% (n=3) Follicular lymphoma. The use of immunohistochemistry resulted in a change in diagnosis for 31.4% (n=32) of patient. The most common changed diagnosis was Burkitt Lymphoma and Sarcoma. Conclusion: Immunohistochemistry is critically important for accurate diagnosis of pediatric cancer, with over 30% of all cases identified as having treatment changing diagnoses. IHC training is critical and a limited common biomarker panel can successfully be used in low resource countries to improve treatment selection. Citation Format: Jeffer Bhuko, Caroline Minja, Michael McDermott, Maureen Osullivan, Trish Scanlan, Kristin Schroeder. Impact of Immunohistochemistry on Diagnostic Accuracy for Pediatric Cancer in Tanzania [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 4.

The Significant Impact of Immunohistochemistry in the Classification of Lung Carcinoma on Small Biopsies

Background : There are limitations of histomorphology in the appropriate categorization of lung carcinoma where immunohistochemistry can confirm the morphological diagnosis and may add value in the poorly differentiated and undifferentiated tumors. The aim of the study was to assess the role of immunohistochemistry in classifying lung carcinoma on small biopsy samples. Methods and Material: A retrospective hospital based, observational study was conducted on cases of lung carcinoma diagnosed by core needle or bronchoscopic biopsies over a 3- year period. After evaluation of clinical findings and H&E sections, all biopsies were evaluated by immunohistochemical staining. The immunohistochemistry panel included cytokeratin cocktail, CK7, CK 20, TTF1, Napsin A, CK5/6, p40, synaptophysin, chromogranin, CD 56. Result: Out of 78 cases, the mean age was 58 +/- 11 years. Most prevalent malignancy type was adenocarcinoma (30, 38.1%). Adenocarcinoma cases were positive for CK7 (25/26, 96%), Napsin A (24/26, 92%), TTF1 (15/30, 50%) and negative for CK 20. Squamous cell carcinoma cases showed positivity for p40(18/22, 82%) and CK 5/6 (17/22.71%).Small cell carcinoma showed positivity for neuroendocrine markers synaptophysin (5/7,71%) and chromogranin(4/7, 57%) and CD 56 (6/7cases (85%).88% of small cell carcinomas,75% of adenocarcinomas and 72 % of squamous cell carcinomas were accurately diagnosed by morphology. Morphologic prediction was poor in the NSCC NOS group (0%) and poorly differentiated carcinomas (64%), which were finally, diagnosed by immunohistochemistry.In the morphologically diagnosed cases, immunohistochemistry confirmed the diagnosis. Conclusion: Thus, morphology added with immunohisto chemistry provides a crisp diagnosis thereby improving therapeutic efficacy

Impact of immunohistochemistry on the diagnosis and management of primary aldosteronism: An important tool for improved patient follow-up.

Primary aldosteronism is a common cause of secondary hypertension. Primary aldosteronism is caused by an aldosterone-producing adenoma or bilateral hyperplasia that in some cases is asymmetrical with one adrenal dominating aldosterone secretion. Most patients with aldosterone-producing adenoma are biochemically cured by unilateral adrenalectomy, but patients with bilateral hyperplasia have a significant risk of residual or recurrent disease. Here, immunohistochemistry of CYP11B1 and B2 was used to investigate whether these markers could aid in the diagnostic workup of primary aldosteronism patients. A total of 39 patients with primary aldosteronism who underwent unilateral adrenalectomy for a presumed adenoma during 2013-2016 were included. Immunohistochemistry using monoclonal antibodies identifying the enzymes CYP11B1 and B2 was part of routine histopathological workup in 6 cases; in 33 cases, it was applied retrospectively. The hyperplasia diagnosis was suggested when there was no dominating nodule but immunoreactivity for CYP11B2 was seen in several nodules, which were also seen on routine sections. To distinguish between adenoma and hyperplasia, a ratio between the largest and second largest CYP11B2-positive nodules was calculated. In all, 22 patients had an aldosterone-producing adenoma, while 13 patients were judged to have hyperplasia. In four cases, a final diagnosis could not be established, thus these were judged equivocal. Among the 33 cases investigated retrospectively, the primary histopathological diagnosis was altered from hyperplasia to aldosterone-producing adenoma in 9 cases (27%) after immunohistochemistry, and the immunohistochemically rectified adenoma group displayed improved clinical cure rates compared to the routine H&E-diagnosed cohort. Moreover, the B2 ratio was significantly higher in adenoma than in hyperplasia and equivocal cases. Immunohistochemistry detecting CYP11B1 and B2 expression is of great help in establishing a final histopathological diagnosis in patients with primary aldosteronism. This procedure should be part of the histopathological routine in all operated primary aldosteronism patients.

Prognostic Factors and Impact of Immunohistochemistry in the Management of Biliary Tract Cancer– A Single Center Experience in Germany

Prognostic Factors and Impact of Immunohistochemistry in the Management of Biliary Tract Cancer– A Single Center Experience in Germany

Impact of immunohistochemistry in sentinel lymph node biopsy in head and neck cancer

To determine the sensitivity, specificity, negative predictive value (NPV) and accuracy of hematoxylin-eosin (HE) staining compared to immunohistochemistry (IHC) in sentinel lymph node (SLN) histological analyses of head and neck squamous cell carcinoma. The Clinical prospective study was carried out at Tertiary referral university hospital. Patients with oral, lip and oropharyngeal squamous cell carcinoma undergoing elective neck dissection with clinically and radiologically negative necks were included. All patients were submitted to computer tomography scan for the evaluation of lymphatic metastases. The surgical procedure consisted of tumor resection, SLN sampling and elective neck dissection. Negative SLNs via HE were then submitted for IHC analysis of cytokeratin AE1/AE3 and step serial section (SSS). The main outcome measures were the negative predictive value of conventional HE staining techniques in the diagnosis of lymphatic metastases with the SSS/IHC analysis. Of 46 patients undergoing 63 neck procedures, 53 were SLN negative and 10 were positive on HE analysis. Using SSS/IHC analysis of these 53 negative SLNs on HE, two (3.8 %) were found to be positive. For HE, the sensitivity, specificity, NPV and accuracy were 77, 100, 94, and 95 %, respectively. With subsequent analysis with SSS/IHC, these values increased to 92, 100, 98 and 98 %, respectively. SSS/IHC is important in SLN analysis as the false negative rate decreased significantly while increasing the inherent sensitivity of the analyses.

The impact of immunohistochemistry on sentinel node biopsy for primary cutaneous malignant melanoma

Sentinel node biopsy (SNB) has emerged as an accurate means of identifying nodal disease in patients with malignant melanoma. Superselection of pathological nodes has allowed improved pathological staging of disease. The aim of this study was to look at the impact of immunohistochemistry on pathological staging of sentinel nodes. The first 100 patients undergoing SNB for primary cutaneous malignant melanoma were included in this study. Sentinel node harvesting was performed with the aid of preoperative lymphoscintigraphy and the intraoperative use of both a gamma probe and blue dye. If the sentinel nodes contained tumour on either routine pathology or immunohistochemistry, patients were offered a therapeutic lymph node dissection (TLND). Patients underwent no other treatment to the primary lymph node basin if the sentinel node was free of metastases. In all, 95 patients had at least one node identified, and 25 were staged SNB positive and offered subsequent TLND. We found that 76% (19/25) of SNB positive patients were staged positive on routine pathology, and 24% (6/25) were staged with immunohistochemistry. Immunohistochemistry upstaged disease in 8% of patients (6/76). In all, 21 of the patients staged positive with SNB underwent TLND; 50% (8/16) of the patients staged sentinel node positive with routine pathology showed no further disease in the TLND, compared with 100% (5/5) of the patients staged sentinel node positive with immunohistochemistry only ( P<0.05). Three patients have developed recurrence within the nodal basin following a negative SNB. The sensitivity of the procedure is currently 89% (25/28), with a mean follow-up of 24 months. Immunohistochemistry is an essential part of identifying micrometastasis in sentinel nodes, upstaging 8% of patients in our series. Patients with micrometastatic disease may well have a different prognosis from those with occult disease, and careful delineation of these patients is required to determine the prognostic influence of micrometastasis.